Al-Moraissi Essam Ahmed, Ellis Edward
Assistant Professor, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Thamar University, Thamar, Yemen.
Professor and Chair, Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center, San Antonio, TX.
J Oral Maxillofac Surg. 2015 Mar;73(3):482-93. doi: 10.1016/j.joms.2014.09.027. Epub 2014 Oct 12.
The purposes of this study were to identify significant differences in clinical outcomes between open reduction and rigid internal fixation (ORIF) and closed treatment (CT) for adult mandibular condylar fractures (MCFs) and to support or refute the superiority of one method over the other.
To address our purpose, we designed and implemented a systematic review with meta-analysis. A comprehensive electronic search without date and language restrictions was performed in May 2014. The inclusion criteria were studies in humans, including randomized or quasi-randomized controlled trials, controlled clinical trials, and retrospective studies, that compared ORIF and CT regarding maximal interincisal opening, laterotrusive and protrusive movements, pain, malocclusion, chin deviation on mouth opening, and temporomandibular joint signs or symptoms for the management of unilateral or bilateral adult MCFs. Meta-analysis was conducted only if there were studies of similar comparisons reporting the same outcome measures. For binary outcomes, we calculated a standard estimation of the odds ratio by the random-effects model if heterogeneity was detected; otherwise, a fixed-effects model with a 95% confidence interval was performed. Weighted mean differences or standard mean differences were used to construct forest plots of continuous data.
Twenty-three publications were included: 5 randomized controlled trials, 16 controlled clinical trials, and 2 retrospective studies. Five studies showed a low risk of bias, whereas 18 showed a moderate risk of bias. There were statistically significant differences between ORIF and CT regarding maximal interincisal opening, laterotrusive movement, protrusive movement, malocclusion, pain, and chin deviation on mouth opening (P = .001, P = .001, P = .001, P = .001, P = .001, and P = .05, respectively).
The result of the meta-analysis confirmed that ORIF provides superior functional clinical outcomes (subjective and objective) compared with CT in the management of adult MCFs.
本研究旨在确定成人下颌骨髁突骨折（MCF）切开复位坚强内固定术（ORIF）与闭合治疗（CT）在临床疗效上的显著差异，并支持或反驳一种方法优于另一种方法的观点。
为实现研究目的，我们设计并实施了一项荟萃分析的系统评价。2014年5月进行了无日期和语言限制的全面电子检索。纳入标准为针对人类的研究，包括随机或半随机对照试验、对照临床试验和回顾性研究，这些研究比较了ORIF和CT在单侧或双侧成人MCF治疗中关于最大切牙间开口度、侧方移位和前伸运动、疼痛、错牙合、张口时颏部偏斜以及颞下颌关节体征或症状等方面的情况。仅当有类似比较且报告相同结局指标的研究时才进行荟萃分析。对于二元结局，如果检测到异质性，我们通过随机效应模型计算优势比的标准估计值；否则，采用具有95%置信区间的固定效应模型。加权平均差或标准平均差用于构建连续数据的森林图。
纳入23篇文献：5项随机对照试验、16项对照临床试验和2项回顾性研究。5项研究显示偏倚风险较低，而18项显示偏倚风险中等。在最大切牙间开口度、侧方移位运动、前伸运动、错牙合、疼痛和张口时颏部偏斜方面，ORIF和CT之间存在统计学显著差异（分别为P = 0.001、P = 0.001、P = 0.001、P = 0.001、P = 0.001和P = 0.05）。
荟萃分析结果证实，在成人MCF的治疗中，与CT相比，ORIF能提供更优的功能性临床结局（主观和客观）。
